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Sunday, May 19, 2024

PhilHealth defers circular on claims payments; PHA grateful

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The Philippine Health Insurance Corp. (PhilHealth) on Sunday it would defer a circular that temporarily suspended claims payments to hospitals, as the state insurer continues dialogues with them.

"In the meantime, we suspended the implementation of that circular.

Because we also need to have that circular. We have to address insurance fraud," said PhilHeath vice president for corporate affairs and spokesperson Dr. Shirley Domingo.

"We are not holding anything even as the investigation is ongoing. We can't just put it on hold," added Domingo in an interview over Dobol B sa TV.

Philippine Hospital Association President Dr. Jaime Almora welcomed the move, saying the announcement “is a happy culmination of a long negotiation where the voice of the people has finally prevailed.”

“We express our gratitude for those in Congress that served as our voice," added Almora, whose group represents over 2,000 medical institutions.

Various hospital groups announced on August 21 they were considering terminating their relationship with PhilHealth soon after the state insurer issued a circular about the Temporary Suspension of Claim Payments under investigation for fraud. They threatened to leave the state health insurer by October.

PhilHealth's Circular No. 2021-0013 provides the guidelines on the TSPC as a preventive measure against healthcare providers that are subject of investigation.

As to the supposed fraudulent claims, Dr. Almora said PhilHealth should pay the claims, except those that are found to be fraudulent.

He added that the identification of "fraudulent claims" is a continuing process.

“But some of our members suspected that the circular might have been used as an excuse to avoid paying the claims," Almora said.

The circular states that payment is suspended on claims that are subject of investigations pertaining to fraudulent, unethical acts, and/or abuse of authority.

On the other hand, Almora pointed out the huge "discrepancy" between the PhilHealth's payable amount and PHA members' claims.

“PhilHealth should solve its internal problem," Almora said.

Domingo said they first held a dialogue with Health Undersecretary Leopoldo Vega and hospitals regarding the delayed hospital payments, prompting them to suspend the circular.

Despite several hospitals lamenting delayed payments, Domingo said they are not holding any hospital claims since the pandemic started.

During the House investigation on the issue last week, PhilHealth said it has yet to pay P21 billion claims filed by hospitals.

However, Domingo clarified that this amount is not only debts but payments that are under process.

"It's not all debts. We are given 60 days to process these claims," she added.

Senator Christopher "Bong" Go said concerned agencies can come up witha win-win solution that would not hamper or adversely affect servicesneeded by ordinary Filipinos during this public health emergency.

The senator, chair of the Senate health committee, reached out toPhilHealth President Dante Gierran, Executive Secretary Salvador Medialdea and Secretary Carlito Galvez Jr. to help resolve some issues raised by hospital associations and protect the stability of the health system.

“Let us give them an extension because we are in a different situation now. We are facing a pandemic and we need to help each other to cope up with this and protect the lives of our people," he said.

While he supports PhilHealth’s intention to reform their system to protect public funds against abuses, “let us also be considerate of the ordinary Filipinos who can go nowhere to ask for help," noted Go.

As the country is still in a public health emergency, Go said that government agencies need to be more flexible so they can prioritize what Filipinos need at this time.

Go further asked hospitals to follow the proper procedures and be truthful in their claims, particularly in these exceptional circumstances due to the pandemic. 

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